ABSTRACT: We propose to perform and study an implementation of a clinical quality management system (CQMS) to improve health care decision making through the use of integrated data and knowledge management. This CQMS will be implemented in three federally qualified health centers serving a number of AHRQ priority populations including urban, low income, and rural underserved populations. We propose a novel approach to implementing the CQMS using cognitive engineering techniques to facilitate analysis and change of organizational routines to support full integration and use of the system. Using a mixed methods stepped- wedge research and evaluation design, we will describe barriers and facilitators, measure and describe the acceptability and effectiveness of the implementation method, and measure the effect of the implementation on the use of best evidence in patient care. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Information technology can improve health care decision making, but implementing it often means making significant changes in how clinics organize their workflows. Those changes are difficult, and change efforts not infrequently fail. We will combine the findings of research on organizational routines from fields outside of medicine with proven cognitive engineering tools to develop and demonstrate an effective and reliable approach to implementing health IT, and show that it improves patient care measures.